Become a Member

The requirements to become a member are as follows:

Must be an OB-GYN physician.
Be in practice in the South Florida area for at least one year
Should complete a membership application
Please have one active member of the Society send letter of endorsement and one active member send letter to propose.

If approved by the board, applicant becomes an Associate Fellow. After a 2 year period, the Board will approve the Associate Fellow to Fellow status.

The membership fees are $350.00/ year which include 4 meetings held annually.

Please complete the online form, or download the form by clicking the button below.

Name*
First Last
Date of Birth
MM slash DD slash YYYY
Home Address*
Street Address Address Line 2 City State ZIP Code
Office Address*
Street Address Address Line 2 City State ZIP Code
Office Phone*
Fax
Email*
Website
Medical School*
Location*
Year of Graduation*
MM slash DD slash YYYY
Residency & Post Graduate Training*
Location*
Dates*
Diplomate of ABOG*
- Yes
- No
If Yes, Dates*
Diplomate Subspecialty Board (Please Specify):*
Date*
MM slash DD slash YYYY
Present Hospital Affiliation(s):*
University Affiliations (Past and Present):*
NOTE: The above information should account for ALL time since graduation from medical school.
C.V. Upload*
Max. file size: 8 MB.
Please attach current C.V. 8MB max file size.
Proposed By:*
Endorsed By:*